Dr. Vivek Rao, Chief, Division of Cardiovascular Surgery with the Peter Munk Cardiac Centre, prepares an aortic valve replacement during open heart surgery on a sixty nine year old Michael Joseph Towns on April 10 2014. The patient was having an aortic valve replaced during the 3 + hour operation. (Fred Lum/The Globe and Mail)

Dr. Vivek Rao, Chief, Division of Cardiovascular Surgery with the Peter Munk Cardiac Centre, prepares an aortic valve replacement during open heart surgery on a sixty nine year old Michael Joseph Towns on April 10 2014. The patient was having an aortic valve replaced during the 3 + hour operation.(Fred Lum/The Globe and Mail)

How doctors are using a simple test in surgery to save blood – and money
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When Mike Towns went in for cardiac surgery recently, doctors hoped to save two things: his heart, and a few units of blood.

The 69-year-old retired owner of a general store in Duoro, a small town outside Peterborough, Ont., was having his aortic valve replaced at Toronto’s Peter Munk Cardiac Centre, where doctors have piloted an innovative bedside-testing regime to reduce the amount of blood and blood products pumped into patients at the end of heart surgery.

Globe and Mail Update Apr. 21 2014, 12:18 PM EDT

Video: How a new blood test is reducing unnecessary blood transfusions

Dr. Vivek Rao, Chief, Division of Cardiovascular Surgery with the Peter Munk Cardiac Centre, prepares an aortic valve replacement during open heart surgery on a sixty nine year old Michael Joseph Towns on April 10 2014. The patient was having an aortic valve replaced during the 3 + hour operation.
The Globe and Mail

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The new protocol has driven down the cardiac centre’s use of red blood cells by 20 per cent and blood products by 40 per cent, saving the hospital more than $1-million so far.

The pilot project, which is set to expand to a dozen other Canadian hospitals beginning in September, is part of a larger movement toward conserving blood in this country.

Experts say that movement will be critical to prevent blood shortages as the population ages. The older the baby boomers get, the more they are expected to require complex treatments that include transfusions and the less they are expected to roll up their sleeves and donate blood.

It’s a looming demographic development that could begin to drain the country’s blood banks and drive up the cost of a system that already costs more than $465-million a year in provincial and territorial funding to operate.

“There are calculations that suggest now that our blood has run out … we only produce just enough to support cancer patients and surgical patients right now. Just enough,” said Stuart McCluskey, medical director of the blood-conservation program at Peter Munk Cardiac Centre, which is located at Toronto General Hospital.

“There’s a finite amount of donors. This is such an important initiative because the only way to make the balance sheet work is to reduce the utilization of blood when it’s not needed.”

A 2012 study in the journal Transfusion projected that demand for blood could begin exceeding supply the same year the paper was published.

The researchers dug into the 2008 figures for blood donation and blood use in Ontario – a province they considered a fair proxy for supply and demand rates in the rest of the country – and then extrapolated out to the year 2036. If the trends hold, red blood cell “demand is forecasted to outstrip supply as soon as 2012,” the study concluded.

The researchers calculated that, thanks to the grey wave, the gap would widen to a chasm by 2036, when red-blood cell transfusions to the over-70 set would make up 68 per cent of all transfusions, up from 53 per cent in 2008.

So far, the study’s early predictions have not come to pass.

Canadian Blood Services, which manages the blood system in every province and territory but Quebec, says there has not been a national blood shortage – defined as less than two days’ supply on CBS’s shelves – since the agency was founded in 1998 in the wake of the tainted blood scandal.

There have been occasional shortfalls of platelets, the cells in blood that clot to keep people from bleeding, around the Christmas holidays. Those have typically been resolved in a day or two, CBS said. (Maintaining platelet supplies can be tricky because platelets are only good for five days. Red blood cells keep for 42 days and plasma, which can be frozen, keeps for years.)

CBS says donation rates have not budged in a decade, with fewer than 4 per cent of eligible donors rolling up their sleeves every year.

That suggests the lack of shortages is thanks mostly to less demand, not more supply.

“We’ve actually seen blood demand decrease in the last five years,” said Kathryn Webert, medical director of utilization management for CBS. “That wasn’t necessarily predicted.”

Some of the drop is due to changes in medical technology, Dr. Webert said. For instance, a pleasant side effect of the rise of minimally invasive surgeries has been a reduction in blood use.